A Preliminary Evaluation of the Capitation Pilot Program in Taipei Metropolitan Area under the National Health Insurance in Taiwan.

• Main Authors: Chih-Ming Chang, 張志銘
• Other Authors: Shou-Hsia Cheng
• Format: Others
• Language: zh-TW
• Published: 2013
• Online Access: http://ndltd.ncl.edu.tw/handle/67y42h

碩士 === 國立臺灣大學 === 健康政策與管理研究所 === 101 === Background: On July 2011, a "Capitation Program”was implemented by National Health Insurance (NHI) without registrating with GP required and gatekeeping system, which expected to promote health and downsize health care expenses. Objectives: This study aimed to evaluate the impact of a Capitation Program in Taipei Metropolitan Area on health care utilization and outcomes. Methods: This study adopted the NHI claim data from 2010 to 2012. Patients who joined Capitation Program were recruited as the intervention group and those who never joined Capitation Program were recruited as the comparison group. We used a propensity score matching to select patients in the comparison group to minimize the selection bias. After controlling patients’ characteristics (gender, age, insured category, catastrophic illness or not, Charlson comorbidity index), Generalized Estimating Equation (GEE) were applied to predicted the probability of patients’ enrollment in the Capitation Program. Then we use Difference-in-Difference method to evaluate the impact of the Capitation Program by comparing the health care utilization and outcomes between these two groups. Results: Patients enrolled in the Capitation Program underwent significantly lower physician visits, ambulatory expenses, expenses for all health services and UPC in the model of hospital loyal patient after enrollment. While in the model of area capitation, the physician visits, expenses for all health services and UPC are significantly higher after enrollment. After matching, the health care utilization of patients in the intervention group had a significantly lower number of physician visits in only the model of hospital loyal patient. Concerning the health care outcomes, emergency visits of patients in the intervention group had a significantly lower number in only the loyal patient model while ACSCs is not significant higher. Conclusions and Suggetstions: The program seemed to decline the physician visits of the model of hospital loyal patient, whereas health care outcomes are the same. We suggest that it is necessary for BNHI to evaluate the long term effect on health care utilization outcomes of the Capitation Program. Additional research is required to understand the bussiness strategies of hospital.